US5565462A - Composition for topical treatment of psoriasis and atopic dermatitis comprising a xanthine derivative - Google Patents

Composition for topical treatment of psoriasis and atopic dermatitis comprising a xanthine derivative Download PDF

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US5565462A
US5565462A US08/263,399 US26339994A US5565462A US 5565462 A US5565462 A US 5565462A US 26339994 A US26339994 A US 26339994A US 5565462 A US5565462 A US 5565462A
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treatment
psoriasis
pentoxifylline
atopic dermatitis
topical
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Anat Eitan
Rachel Nachman
Sasson Cohen
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Teva Pharmaceutical Industries Ltd
Ramot at Tel Aviv University Ltd
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Teva Pharmaceutical Industries Ltd
Ramot at Tel Aviv University Ltd
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A61K31/52Purines, e.g. adenine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00Drugs for dermatological disorders

Definitions

  • This invention relates to topical pharmaceutical compositions for and a method of treating inflammatory and proliferative skin diseases such as psoriasis and atopic dermatitis.
  • Psoriasis is a common chronic relapsing inflammatory skin disease which affects 1-3% of the population. It is characterised by the circumscribed scaling erythematous plaques of various sizes and forms which in some cases may extend to more than 50% of the skin area.
  • the psoriatic condition is composed of two main processes: cellular hyperproliferation and inflammation. Despite extensive research the etiology of the disease is still unknown.
  • Psoriasis is currently treated by a number of methods which include topical applications consisting of tar derivatives, steroids, vitamin D and its derivatives or vitamin A and its derivatives (J. P. Callen, Drug Therapy, April 1987, pp. 29-35). These therapies are only partially successful and may be accompanied by undesired side affects. Thus although steroids can be very effective, they are also frequently associated with side effects. Other therapies include phototherapy with or without concomitant systemic administration of psoralen derivatives. Additionally, systemic administration of steroids, methotrexate and cyclosporine have been used for treatment of severe cases of psoriasis. All of these therapies are associated with side effects. There is thus an urgent need for new effective, non-toxic therapeutics for psoriasis.
  • Atopic dermatitis is a chronic skin condition of unknown etiology, and which may be continuous from infancy to adulthood. There is about 4% incidence of atopic dermatitis from birth to 7 years (Halpern et al., J. Allergy Clin. Immunol. 51:139-151 (1973). In childhood, it is characterized by papules, erythema, thickening and lichenification. In the adolescent, the main symptoms are thickening and lichenification with erythema and scaling. Pruritis is a general feature of the disease. Systemic therapy includes antihistamine drugs and steroids, but the latter are reserved for unmanageable cases and used for the shortest period possible. Topical therapy includes fluorinated and fluorochlorinated corticosteroid preparations, but striae and cataracts are likely complications. Clearly there is as yet no satisfactory and safe drug treatment for atopic dermatitis.
  • Xanthine derivatives have been proposed for the treatment of psoriasis and atopic dermatitis.
  • U.S. Pat. No. 4,141,976 proposes certain pharmaceutical preparations for the topical treatment of psoriasis.
  • the compounds described are certain substituted alkylxanthine derivatives and substituted thioxanthines.
  • RO 20-1724 d,1-4-(3-butoxy-4-methoxybenzyl)-2-imidazolidinone, which is not a xanthine derivative.
  • RO 20-1724 d,1-4-(3-butoxy-4-methoxybenzyl)-2-imidazolidinone
  • WO 9101730 describes the use of certain xanthine derivatives for the treatment of asthma, urticaria, eczema and rhinitis. Suggested modes of administration are listed as oral, rectal, topical, parenteral, intravenous, or intramuscular or through the respiratory tract.
  • EP 195,496 describes the use of certain xanthine derivatives for treating proliferative skin disease such as psoriasis. The xanthine derivatives are administered orally.
  • U.S. Pat. No. 4,716,165 describes the use of certain theobromine derivatives for treating asthma, allergic rhinitis, atopic dermatitis or eczema.
  • WO 8905145 describes the use of certain xanthine derivatives for the treatment of a wide variety of disease states including psoriasis.
  • EP 260,127 describes the oral administration of certain xanthine derivatives for the treatment of proliferative skin disease.
  • U.S. 4,341,783 describes the use of topical dyphylline for the treatment of psoriasis.
  • Pentoxifylline (3,7-dimethyl-1-(5-oxohexyl)-xanthine), propentofylline (PPF) (3-methyl-7-propyl-1-(5-oxohexyl)-xanthine) and torbafylline (TBF) (3-methyl-7-ethoxymethyl-1-(5-hydroxy-5-methylhexyl)-xanthine are related methyl-xanthine derivatives which are well known in the art for treatment of a variety of disease states.
  • PTX is widely used systemically for the treatment of peripheral vascular diseases.
  • PTX and PPF have been administered systemically for the treatment of senile dementia while systemic administration of TBF is under investigation for treatment of senile dementia, peripheral vascular disease and myopathy.
  • PTX has been used systemically for the treatment of various cutaneous lesions associated with or due to impaired or deficient blood flow in the dermis layer of skin and its effectiveness in the treatment of peripheral vascular diseases is described by H. Ely, Dermatologic Clinics 6:585-608 (1988). There is no teaching that PTX, or any of its congeners, PPF or TBF, were effective in the treatment of psoriasis or atopic dermatitis, which are lesions of the epidermis layer of the skin rather than one of the peripheral blood vessels.
  • a pharmaceutical composition comprising a compound selected from the group of pentoxifylline, propentofylline and torbafylline dramatically improves the psoriatic lesions of patients.
  • the improvement is greater than that achieved with other xanthine derivatives such as dyphylline which are taught in the prior art as useful for the topical treatment of psoriatic lesions.
  • the present invention provides a pharmaceutical composition for the topical treatment of psoriasis or atopic dermatitis comprising an effective amount of an active compound selected from the group of pentoxifylline, propentofylline and torbafylline, and a pharmaceutically acceptable carrier.
  • the concentration of the active compound is about 0.5%-5% (w/w).
  • the active compound is pentoxifylline its concentration is preferably 2% (w/w).
  • compositions according to the invention may additionally contain therapeutically effective amounts of one or more compound which are known to be of use in the topical treatment of psoriasis and atopic dermatitis.
  • compounds are well known to those skilled in the art and include cyclosporine, methotrexate, tamoxifen, forskolin and analogs, tar derivatives, steroids, vitamin A and its derivatives vitamin D and its derivatives including 1-alpha-hydroxy-cholecalciferol, 1,25-dihydroxy-cholecalciferol, 24,25-dihydroxy-cholecalciferol, 1,24-dihydroxy-cholecalciferol and calcipotriol (MC 903), and beta agonists such as terbutaline.
  • compositions according to the invention may contain one or more of the compounds adenosine and related purines, lipoxygenase inhibitors, substance P antagonists, delta tocopherol, 2-heptanone, and fatty acids and their esters such as heptanoic acid, ethyl heptanoate, 3,3-dimethylbutyric acid, and lipoic acid.
  • the pharmaceutically acceptable carrier of the compositions according to the invention may contain any of the components which are used in topical compositions and are well known to those skilled in the art.
  • the pharmaceutically acceptable carrier of the compositions according to the invention may also contain penetration enhancers such as urea, lactic acid, ammonium lactate, salicylic acid or a C 3 -C 12 -straight chain alkanoic acid.
  • penetration enhancers such as urea, lactic acid, ammonium lactate, salicylic acid or a C 3 -C 12 -straight chain alkanoic acid.
  • compositions may be in the form of lotions, creams, ointments and gels, and also in the form of sprayable aerosols.
  • Preferred formulations of the compositions according to the invention are creams, which may further contain saturated or unsaturated fatty acids such as stearic acid, palmitic acid, oleic acid, palmito-oleic acid, cetyl or oleyl alcohols, stearic acid being particularly preferred.
  • Creams of the invention may also contain a non-ionic surfactant, typically polyoxy-40-stearate.
  • the invention also provides a method for the treatment of a subject suffering from psoriasis or atopic dermatitis comprising topically applying to the subject a therapeutically effective amount of an active compound selected from the group consisting of pentoxifylline, propentofylline and torbafylline if desired together with a pharmaceutically acceptable carrier.
  • the preferred active compound for the performance of the method according to the invention is pentoxifylline.
  • the said active compound may be applied together with a therapeutically effective amount of one or more additional compounds which are known to be of use in the topical treatment of psoriasis and atopic dermatitis.
  • additional compounds which are known to be of use in the topical treatment of psoriasis and atopic dermatitis.
  • These compounds are well known to those skilled in the art and include cyclosporine, methotrexate, tamoxifen, forskolin and analogs thereof, tar derivatives, steroids, vitamin A and its derivatives, or vitamin D and its derivatives including 1-alpha-hydroxy-cholecalciferol, 1,25-dihydroxy-cholecalciferol24,25-dihydroxy-cholecalciferol,1,24-dihydroxy-cholecalciferol and calcipotriol (MC 903), and beta agonists such as terbutaline.
  • the said active substance may be applied together with an effective amount of at least one member of the group of adenosine and related purines, lipooxygenase inhibitors, substance P antagonists, delta tocopherol, 2-heptanone, and fatty acids and their esters such as heptanoic acid, ethyl heptanoate, 3,3-dimethylbutyric acid, and lipoic acid.
  • the invention provides for use of a compound selected from the group consisting of pentoxifylline, propentofylline and torbafylline for the preparation of pharmaceutical compositions for the topical treatment of human patients suffering from psoriasis of atopic dermatitis.
  • Example 1 the advantages achieved in accordance with the invention are described, i.a. with reference to the annexed pictures in which:
  • FIG. 1 shows photomicrographs of transverse sections of human psoriatic skin transplants before and after treatment
  • FIG. 2 shows two further similar photomicrographs.
  • Pentoxifylline was formulated into a cream for topical application as follows:
  • Pentoxifylline was formulated into an ointment for topical application as follows:
  • Pentoxifylline was formulated into a gel suitable for topical application as follows:
  • the severity of the psoriatic lesion was evaluated and the PASI index was calculated as described by Fredrikson and Petterson (Dermatologica 157:238-244 (1978)).
  • the area (A) of the psoriasis in four main body parts (head (H), trunk (T), upper extremities (U) and lower extremities (L)) is assigned a value from 0-6 depending on the extent of psoriasis where O reflects no involvement and 6 reflects 90-100% involvement.
  • the severity of the lesion is assessed based on three parameters: Erythema (E), Desquamation (scaling) (D) and Infiltration (I). The severity of each of these parameters is measured on a scale of 0-4 where 0 is no involvement and 4 is very sever.
  • the total severity score is calculated according to the following formula:
  • split thickness biopsies of nonpustular psoriatic human tissue, 4 ⁇ 5 cm and 0.4 mm thick were obtained from the edge of established plaques from various donor patients. Each specimen was divided into sections as follows: 4-5 sections, 2 ⁇ 2 mm each for thymidine incorporation and subsequent autoradiography in order to assess the rate of proliferation in the epidermis; 1-2 sections 0.5 ⁇ 1 cm each for histological examination prior to grafting in order to evaluate the severity of the disease, as quantitated by the measure of epidermal thickness; and 3 sections 1.5 ⁇ 1 cm each for grafting on the dorsal side of each of three different nude mice. The grafts were allowed to heal for one week prior to topical application of the test preparations.
  • mice Outbred Balb/C nude mice, 2 to 3 months of age were used in this study.
  • the mice were obtained from the pathogen free animal breeding facility at the University of Tel Aviv (Israel) and were raised in the pathogen-free animal facility at the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
  • the graft area was treated daily with the test drug in a cream composition according to Example 1 or vehicle alone by applying 200 ⁇ l of the preparation, once at 08:00 and once at 21:00 for the duration of 7 days.
  • Table 1 shows the effect of the topical preparations tested on human psoriatic skin transplanted in nude mice according to the procedure outlined above.
  • the results of the experiment shown in Table 1 demonstrate that pentoxifylline is almost as effective as steroids in treating psoriasis and far more effective than dyphylline, a related xanthine which was shown to be virtually inactive.
  • Table 2 shows the results of the application of topical skin formulations to transplanted human psoriatic skin in each of the 28 nude mice. The results are expressed as a success ratio where success is defined as a decrease of at least 15% in epidermal thickness (acanthosis) as a result of the 7 day topical treatment. The treatments were applied as creams and were administered as described above.
  • Panel A shows a transplant before treatment and panels B and C show transplants after daily treatments for seven days with the 2% PTX cream of Example 1 and an 0.05% clobetasol propionate ointment, respectively.
  • FIG. 2 shows similar photomicrographs before and after daily treatment for seven days with 8% dyphylline.
  • atopic dermatitis is transferable by bone marrow cells indicating that primary site of disease is in the immune and inflammatory cells which infiltrate the skin.
  • lymphocytes are thought to be one of the targets for treatment of the disease.
  • various cells (including lymphocytes) and organs derived from atopic subjects showed a common impaired response to cAMP agonists.
  • atopic lymphocytes behavior in response to various agents is predictive of the atopic individuals response to these agents.
  • cAMP agonists have an inhibitory effect on the mitogenic stimulation of peripheral blood mononuclear cells (PBMC) from atopic subjects (Ravid et al., J. Allergy Clin. Immunol. 86:881-885 (1990)).
  • PBMC peripheral blood mononuclear cells
  • steroids such as dexamethasone, which are used in the treatment of atopic dermatitis, inhibited the mitogenic stimulation of PBMC.
  • the inhibitory effect of certain compounds on the mitogenic stimulation of PBMC isolated from healthy and atopic individuals is predictive of the effect of these compounds in the treatment of atopic diseases, including atopic dermatitis.
  • PBM cells peripheral blood mononuclear cells
  • PBM cells were separated by Ficoll-Hypaque density gradient centrifugation. Partial depletion of adherent cells was achieved by incubating PBM cells for 90 min in plastic petri dishes at 37° C. at a concentration of 5 ⁇ 10 4 cells/mL in RPMI-1640 medium containing 2% heat-inactivated newborn calf serum. The nonadhering cells were stirred gently and carefully collected. The monocyte content of PBM cells was thus reduced to 3-7%.
  • PBM cells were suspended (1 ⁇ 10 4 /mL) in RPMI-1640 medium containing 5% heat-inactivated pooled human AB serum supplemented with penicillin (100 U/mL) and streptomycin (100 ⁇ g/mL). Cells were incubated at 37° C. in a humidified 5% CO 2 -95% air atmosphere in 0.2 mL aliquots in 96-well flat bottomed Cooke microtiter plates. PHA (1 ⁇ g/mL), indomethacin (5 ⁇ g/mL) and various xanthine derivatives were added at initiation of culture. Indomethacin was dissolved in ethanol.
  • a clinical trial was performed comparing a cream composition of 2% pentoxifylline (formulation A of Example 1) to placebo.
  • the trial was randomized, double blind, placebo controlled, right-left comparison within patient design.
  • Two similar plaque areas of psoriasis i.e. both legs or forearms
  • pentoxifylline formulated as in Example 1
  • placebo cream formulated identically but without the pentoxifylline.
  • the cream (formulation A in Example 1) was applied by the patient twice daily.
  • Psoriasis Area Severity Index was calculated for each of the 2 lesions on each patient as follows:
  • Patient 1 After 1.5 weeks of treatment the patient showed a 58% decrease in PASI on the pentoxifylline treated side and 0% decrease in PASI on the placebo treated side.
  • Patient 2 After 2 weeks of treatment the patient showed a 53% decrease in PASI on the pentoxifylline treated side and 34% decrease in PASI on the placebo treated side.
  • Patient 3 After 2 weeks of treatment the patient showed a 73% decrease in PASI on the pentoxifylline treated side and 45% decrease in PASI on the placebo treated side. After 6 weeks of treatment the decrease in PASI on the pentoxifylline treated side was 90% and on the placebo treated side 56%.
  • Patient 4 After 6 weeks of treatment the patient showed a 91% decrease in PASI on the pentoxifylline treated side and 73% decrease in PASI on the placebo treated side. After 8 weeks of treatment the decrease in PASI on the pentoxifylline treated side was 88% and on the placebo treated side 57%.
  • Patient 5 After 2 weeks of treatment the patient showed a 73% decrease in PASI on the pentoxifylline treated side and 25% decrease in PASI on the placebo treated side.
  • Pentoxifylline cream or the placebo (the identical cream, but without the pentoxifylline) were dispensed in identical tubes that were marked for application to right and left sides. Patients were instructed to apply medication twice a day (morning and evening) for four weeks.

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US08/263,399 1991-09-02 1994-06-21 Composition for topical treatment of psoriasis and atopic dermatitis comprising a xanthine derivative Expired - Fee Related US5565462A (en)

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IL9936891A IL99368A (en) 1991-09-02 1991-09-02 Preparations for the treatment of psoriasis and atopic dermatitis, which contain the result of xanthine
IL99368 1991-09-02
US93426892A 1992-08-25 1992-08-25
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